| Doctor Name: | PRAVEENA JYOTHINAGARAM |
| NPI Number: | 1306046859 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | Q4780 |
| Business Practice Address: | 4370 Medical Arts Dr Suite 201 Flower Mound, TX - 750281712 |
| Business Phone Number: | 9722190558 |
| Business Fax Number: | 9724369273 |
| Mailing Address: | 3315 Colorado Blvd, Suite 102 DENTON |
| State: | TX |
| Postal Code: | 762106884 |
| Phone Number: | 9403201708 |
| Fax Number: | 9405655457 |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | Q4780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |